{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:49:54Z","timestamp":1790934594637,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2007,4,20]],"date-time":"2007-04-20T00:00:00Z","timestamp":1177027200000},"content-version":"vor","delay-in-days":3730,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[1997,2]]},"abstract":"<jats:p>\n                    Atypical Atrial Flutter.\n                    <jats:italic>Introduction<\/jats:italic>\n                    : Although the circuit in typical counterclockwise atrial flutter has been clearly delineated, the mechanisms of \u201catypical atrial flutters\u201d have been less well characterized. The purpose of this study was to investigate the ECG and electrophysiologic (EP) characteristics of atypical atrial flutter.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods and Results<\/jats:italic>\n                    : Thirty\u2010three patients with at least one form of atypical atrial flutter underwent EP evaluation with multipolar atrial activation and entrainment mapping. Nineteen patients with clockwise flutter had: (1) stereotypic ECG morphology; (2) same cycle length as counterclockwise flutter; (3) clockwise activation around the tricuspid annulus; (4) recording of discrete split potentials along the length of the crista terminalis, suggesting the presence of conduction block; (5) concealed entrainment from the low right atrial isthmus; (6) successful ablation in this isthmus. Twenty patients with atypical flutter not consistent with a clockwise mechanism (\u201ctrue atypical flutter\u201d) showed: (1) heterogeneous ECG morphology; (2) cycle length shorter than that of clockwise flutter; (3) frequent transitions from and to atrial fibrillation; (4) could be entrained in only six patients and, when accomplished, demonstrated surface fusion when entraining from the low right atrial isthmus.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    : Atypical flutter falls into two broad categories. Clockwise flutter uses the same circuit with the same endocardial barriers as its counterclockwise counterpart and is best con sidered a form of typical flutter. True atypical flutter induced in the EP laboratory is a hetero geneous group of arrhythmias that are transitional to atrial fibrillation. Although it may superficially resemble clockwise or counterclockwise flutter based on the 12\u2010lead ECG alone, the distinction can be readily made from a combined evaluation including activation and entrainment mapping.\n                  <\/jats:p>","DOI":"10.1111\/j.1540-8167.1997.tb00775.x","type":"journal-article","created":{"date-parts":[[2007,4,20]],"date-time":"2007-04-20T11:07:27Z","timestamp":1177067247000},"page":"121-144","source":"Crossref","is-referenced-by-count":118,"title":["Electrocardiographic and Electrophysiologic Characterization of Atypical Atrial Flutter in Man:"],"prefix":"10.1111","volume":"8","author":[{"given":"JONATHAN M.","family":"KALMAN","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JEFFREY E.","family":"OLGIN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LESLIE A.","family":"SAXON","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RANDALL J.","family":"LEE","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MELVIN M.","family":"SCHEINMAN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MICHAEL D.","family":"LESH","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,4,20]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.81.3.1142"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(90)90314-F"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(90)90283-U"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960150910"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.89.5.2117"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(89)91206-X"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.86.4.1233"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.90.6.2804"},{"key":"e_1_2_1_10_2","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1161\/01.CIR.89.3.1074","article-title":"Radiofrequency catheter ablation of atrial arrhythmias\u2014Results and mechanisms","volume":"89","author":"Lesh MD","year":"1994","journal-title":"Circulation"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)91014-9"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00029-4"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.7.1839"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)91065-X"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.94.3.398"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1986.tb06632.x"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(90)91136-T"},{"key":"e_1_2_1_18_2","first-page":"1","article-title":"Radiofrequency ablation of atrial tissue is also effective in atypical atrial flutter","volume":"90","author":"Kirkorian G","year":"1994","journal-title":"Circulation"},{"key":"e_1_2_1_19_2","first-page":"1","article-title":"Radiofrequency catheter ablation of uncommon type atrial flutter","volume":"90","author":"Satake S","year":"1994","journal-title":"Circulation"},{"key":"e_1_2_1_20_2","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1161\/01.CIR.88.4.1647","article-title":"Identification of reentry circuit sites during catheter mapping and CB diofrequency ablation of ventricular tachycardia late after myocardial infarction","volume":"88","author":"Stevenson WG","year":"1993","journal-title":"Circulation"},{"key":"e_1_2_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90793-Z"},{"key":"e_1_2_1_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.87.2.373"},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.86.2.628"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.81.3.762"},{"key":"e_1_2_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90007-8"},{"key":"e_1_2_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.6.1389"},{"key":"e_1_2_1_27_2","article-title":"On the in duction of atrial flutter in man. 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